26 Bile Duct Cancer

Bile Duct Cancer

8

THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 30/04/2017

Table 28.1 Results of combined EBRT and BT

BT, number of fractions, fraction dose, method 192 Ir wire, 15 Gy/75 hours, 2 sessions (schedules changed for some patients)

Results of treatment

Author

Number of patients

EBRT, dose

Prescription depth

Statistical analysis

30 Gy (15 fractions a 2 Gy), since 1985 – 40 Gy in 16 fractions of 2.5 Gy

MS – 10 months, 15% of patients > 2 years

Veeze-Kuijpers et al. [13]

dose prescribed at 10 mm

42

n.d.

BT – 20/24 dose prescribed at 10 mm, 2/24 – 5mm, 7.5 and 7,0 mm in 1/24 patient dose prescribed at 10 mm 2. 43/56 cases - dose prescribed at 10 mm, 4/56 – at 12 mm, 5/56 – at 5 mm

MS – 12 months, (2 years) – 19 months (5 years) – 14 months MS – 10 months, (2 yrs) – 18%, (5 yrs) – 8% 1. OS (2 yrs) – 40% DSS (2 yrs) – 41% LC (2 yrs) – 35% 2. OS (2 yrs) – 31% DSS (2 yrs) – 42% LC (2 yrs) – 65%

50,4 Gy (median), 1.8 Gy/fraction

192 Ir seeds, 20 Gy (median)

Foo et al. [26]

24

p=0.39

HDR, 5 – 10 Gy fractions, total dose 20 – 45 Gy 1. No 2. 18 Gy median (3 x 6 Gy fractions) HDR

30 – 45 Gy in 25 patients

Fritz et al. [27]

30

n.d.

50 Gy (median), fractions 1.8 or 2.0 Gy

1. 153 2. 56

Yoshioka et al. [33]

LC – p=0.094

1. Group I – 41 (+ surgery), Group II – 19 (unresectable)

192 Ir wire 1. 10 Gy 2. 22 – 25 Gy

1. 45 Gy (median) 2. 48 Gy (median)

BT - dose prescribed at 10 mm

1. MS – 24 months 2. MS – 10.4 months

Gonzalez et al. [40]

n.s.

192 Ir wire 25 Gy (mean dose), 15 – 31 Gy

Eschelmann et al. [43]

25 – 56 Gy, fractions 1.8-2.0 Gy

BT - dose prescribed

11

n.d.

at 10 mm MS – 22.6 months

192 Ir wire 27 – 50 Gy (median 39.2)

MS 12 months OS (3yrs) 10% (5yrs) 4% 1. RR – 53% 2. RR – 36%

50 Gy, 25 fractions a 2 Gy

BT - dose prescribed at 5 mm

Takamura et al. [44]

93

n.d.

RR – p>0.05 MDC – p=0.06 OS - p=0.015

1. 17 2.14

36 – 55 Gy (median 50.4)

1. No BT 2. 3 x 5 Gy HDR

BT - dose prescribed at 15 mm

1. MDC – 5 months 2. MDC – 9 months 1. OS (2 y) – 0% 2. OS (2 y) – 21% 1. OS – 3.9 months 2.OS – 9.1 months 1. MS – 4.3 months 2. MS – 9.3 months 1. MS – (2 yrs) - 22 months (5 yrs) – 13 months 2. MS – (5 yrs) – 5 months

Shin et al. [49]

1. No BT 2. median 40 Gy, 4 - 5 fractions, HDR

1. 18 2. 12

median 30 Gy, 19 fractions a 1.6 Gy

BT - dose prescribed at 5 mm

Schleicher et al. [50]

OS – p <0.05

. 40 – 50 Gy (median), fractions a 2.0-2.5 Gy 30 – 62 Gy (median) – 45 Gy, fractions 1.8 to 3 Gy

192 Ir wire 1. No BT 2. 25 Gy

1. 42 2.103

BT - dose prescribed at 5 mm

Kamada et al. [51]

n.d.

192 Ir wire 1. Yes (median 25 Gy) 2. No BT

1. 8 2. 23

BT - dose prescribed at 5-10 mm

Ghafoori et al. [52]

p=0,096

EBRT - external beam radiotherapy, BT – brachytherapy, HDR – high dose rate brachytherapy, LDR – low dose rate brachytherapy, RR – Recurrence Rate, MDC – Median Time to Tumor Recurrence, OS – Overall Survival, DSS - Disease-Specific Survival, MS – Median Survival; n.d. – no data, n.s. – no significant;

11. MONITORING

12. RESULTS

For patients with unresectable disease, many researchers have favoured EBRTwith or without BT to prolong survival. In table 28.1 the patient cohorts are analysed groups are heterogeneous and small but there is a trend in these results. Most frequently overall median survival (OS) ranges from 10 to 15 months. Improvement in survival was correlated with the use of BT with EBRT in some papers [10,38,39], but others have found no evident benefits [40].

Themost common complication is infection. Antibiotic prophylaxis should therefore be given before, during and after the procedure. BT does increase the risk of cholangitis and bleeding from inserting catheters into the biliary tract.